Alcohol Abuse Treatment
The Substance Abuse and Mental Health Services Administration sponsors an annual survey, known as the National Survey on Drug Use and Health (NSDUH). The 2013 report makes notes that an estimated 22.7 million people - ages 12 and up - could benefit from treatment for substance abuse disorder (SUD). Those in need of alcohol abuse treatment are amongst this staggeringly large group.
Staggering Numbers of People Lack Needed Treatment
Despite the huge demand being recognized, a mere 2.5 million actually received treatment from a specialty facility.
This data indicate that the number of individuals who do not receive specialized treatment is in the ballpark of 20 million.
Availability of Alcohol Treatment Centers
The mismatch between those who need treatment and those who actually get it is not due to a limited number of treatment centers. In fact, alcohol abuse treatment options are more accessible than ever before. Unlike twenty years ago, there are now not only thousands of programs that cater to multiple kinds of addictions, but highly specialized alcohol abuse treatment centers that cater to a diverse demographic.
Depending on the center, they may specialize in serving:
- Specific age groups
- Religious and sexual preferences
- Specific behavioral addictions
- Certain mental health issues
No two alcohol abuse treatment centers are alike. Although all programs combine some form of therapeutic and educational treatments and many include a detoxification program of some kind, the way in which they are implemented can be vastly different from one program to the next. Specialized treatment for alcohol abuse can be done in both an outpatient or inpatient capacity. Inpatient treatment lengths can vary, but frequently they last one, two or three months, with the potential to continue for longer stretches of time, if necessary. The cost is another important consideration, as inpatient treatment tends to cost more than outpatient, though it can also provide a much higher level of care. Inpatient programs cost anywhere between $200 to $900 per day and outpatient programs cost anywhere between $100 and $500 per treatment session. These costs will vary by level of care needed, duration of treatment, and location of the program.
Principles of Effective Treatment
Adapted from the National Institute on Drug Abuse's research-backed publication entitled Principles of Drug Addiction Treatment, the following important items hold true for alcohol specific treatment, as well:
- Treatment centers that design programs around their patients have the highest success. Each patient has different needs and a tailored treatment plan should reflect those differences.
- Treatment must be available 24 hours a day, 7 days per week. One of the toughest obstacles to overcome is getting the patient to rehab in the first place. If treatment is not available at the exact time they decide to seek help, an opportunity to help someone is potentially lost.
- Effective alcohol abuse treatment programs address physical, emotional, psychological, social and vocational problems. People that seek help for alcohol abuse have many underlying issues that need to be addressed. Without holistic attention to all aspects of a patient's life, chances of long-term success diminish greatly.
- Treatment of any duration has the potential to help someone with their alcohol recovery. According to studies, patients that continue treatment for a minimum of three months, however, achieve much higher rates of success than those who receive treatment for a lesser amount of time. In order keep patients in treatment for the adequate amount of time, tools must be used to engage and keep patients actively participating.
- Alcohol abuse treatment centers without adequate behavioral counseling services do not fully equip patients to address the motivation behind their abuse or resistance skills and problem-solving abilities. These abilities are extremely important if patients are to leave a rehab center and lead productive lives.
- Many medical rehab centers combine behavioral therapy with medications. Medications are even more important for patients that have both a drug or alcohol abuse problem and a mental disorder (dual diagnosis/co-occurring disorders). Integration of multiple treatments is extremely important.
- The potential for relapse exists, even during the initial rehabilitation period. Alcohol abuse treatment programs must monitor their patients closely. It allows programs to see what is and is not working for a patient and facilitates treatment adjustments for each individual as necessary.
Credit: Partnership for Drug-Free Kids
Alcohol Withdrawal / Detox
Clearly, the outset of alcohol abuse treatment necessitates abstinence from the drug. What might not be common knowledge, however, is that those who have been drinking heavily for a prolonged period of time can enter into a dangerous period of acute alcohol withdrawal soon after their last drink. The timeframe during which the alcohol-dependent person may experience serious acute withdrawal symptoms will vary but, on average, it can start a few hours after the last drink and can then last for 5 days to a week.
Medically managed detoxification can be administered during this timeframe to usher a patient through this withdrawal period as safely and comfortably as possible. A person experiencing acute withdrawal might manifest a condition known as delirium tremens (DTs) that, if left unsupervised, can progress to life threatening seizures. A rehab center for alcohol abuse will provide professional monitoring and typically will administer a benzodiazepine or other sedative medication (Valium, Ativan, Librium, etc.) in an attempt to prevent this from occurring. Additional medications, including anticonvulsants can be added, as necessary. A detox program on its own can cost between $600 and $1,000 per day depending on the length of the detox period.
The goals of medical management of alcohol withdrawal are twofold: 1) to keep the patient safe and clinically stable and 2) to encourage continued treatment of the patient's alcohol abuse disorder that might otherwise abruptly end at the first sign of acute withdrawal symptoms. Medical management of a withdrawal period can begin on an outpatient basis, but tends to be much safer under the round-the-clock monitoring that an inpatient or residential alcohol treatment center can provide. Should withdrawal symptoms escalate to a degree that hospitalization is required, an inpatient setting would facilitate this type of transfer of care.
Pharmacotherapy / Medication for Addiction Treatment
Medication Assisted Treatment (MAT) or Medication Assisted Recovery (MAR) are concepts increasingly incorporated into the management of alcohol abuse as well as other substance abuse disorders. If offered, certain medications are prescribed to the individual undergoing treatment, and then monitored by a physician or other trained professional in the field of addiction medicine.
Medications Prescribed As an Adjunct to Alcohol Abuse Recovery
- Acamprosate (trade name: Campral) - One of the latest medications used to treat alcohol addiction, it's mechanism of action on the GABA and glutamate neurotransmitter systems is thought to play a role in recovery, but isn't fully understood.
- Disulfiram (trade name: Antabuse) - In contrast to Campral, Antabuse is a medication with a long history of use in alcohol abuse treatment. Antabuse inhibits the activity of the dehydrogenase enzyme, which normally processes the breakdown of alcohol in the body. Knowing that unpleasant effects will result from consuming alcohol while on this medication serve as a deterrent to continued use.
- Naltrexone (trade name: Depade, ReVia, Vivitrol) - An opiate antagonist originally developed and used with heroin addiction. The opiate receptor blockade that results was additionally found to reduce the "reward" sensation that came with drinking, and therefore decreased cravings for it.
- Topiramate (trade name: Topamax) - Not FDA approved for treatment. With effects on GABA and glutamate neurotransmission, it has been used off-label to increase outcomes in those treated for alcohol abuse.
More details about these medications, as well as information about alcohol abuse and its treatment can be found on the National Institute of Drug Abuse website.
If you have questions about drug and alcohol abuse treatment programs, help is just a phone call away. Contact our 24-hour helpline, toll-free at 1-888-744-0069Who Answers? for confidential and professional assistance or complete our quick form for alcohol abuse treatment help.
- Substance Abuse and Mental Health Services Administration, Results from the 2013 National Survey on Drug Use and Health: Summary of National Findings, NSDUH Series H-48, HHS Publication No. (SMA) 14-4863. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2014.
- National Institute on Drug Abuse. Principles of Drug Addiction Treatment: A Research-Based Guide. NIH Publication No. 12-4180. December 2012. https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/principles-effective-treatment.
- Alcohol Use Disorders: Diagnosis and Clinical Management of Alcohol-Related Physical Complications. NICE Clinical Guidelines, No. 100. National Clinical Guideline Centre (UK). London: Royal College of Physicians (UK); 2010. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0047840/.
- Substance Abuse and Mental Health Services Administration. Medication and Counseling Treatment. September 2015. http://www.samhsa.gov/medication-assisted-treatment/treatment